Providing answers to common questions we hear from our peers in primary care, as well as the signs and symptoms that may indicate the need for a neurology evaluation.

Baby's head being measured Macrocephaly (6/18/2019) - Macrocephaly is a common reason for referral to Neurology or Neurosurgery, often noted during routine well-care visits with a child’s primary care provider. The incidence of macrocephaly is reported up to 5%(1). There are a number of reasons for macrocephaly, many benign, but others which require more urgent evaluation. What is the definition of macrocephaly? The American Academy of Pediatrics recommends measuring head circumference … Continue reading Macrocephaly
boy with hand on head with headache pain Avoiding Medication Overuse Headache – Primary Steps for Primary Care (3/28/2019) - Headaches are a common complaint to primary care offices. In children, headaches are frequently transient, related to concurrent illness, inadequate hydration, or other common lifestyle factors. Commonly, over-the-counter treatments (i.e. NSAIDs) are recommended for the treatment of acute headache. While this is often effective, for patients with more frequent headaches – the repeated use of pain medications can worsen the headache disorder and produce … Continue reading Avoiding Medication Overuse Headache – Primary Steps for Primary Care
Patient at table writing Testing for Success – Primary Steps for Primary Care (2/26/2019) - Hearing the word “neuropsychological” can make any child feel confused and scared. The idea of testing may also bring up unpleasant associations with school tests or painful shots. At Cook Children’s, our program is developed with kids in mind. Tests are introduced as “games,” and most children find them fun and entertaining. Pediatric neuropsychologists are trained to communicate with young patients and use prizes … Continue reading Testing for Success – Primary Steps for Primary Care
Toe walking (1/9/2019) - Toe walking is one of the most common reasons for a primary care evaluation of abnormal gait. Neurologic etiologies of toe walking are common and most concerning for both parents and their doctors. There may be clues in the patient’s history or physical examination that can help the primary care provider in giving reassurance as well as determining the cause before referral. A toe … Continue reading Toe walking
Transitioning to adult neurology care (1/9/2019) - While “Primary Steps” articles are often written for primary care providers, some subjects are equally valuable to patients, their families and their speciality providers. Moving from a pediatric care provider to an adult care provider is likely to be very challenging for many patients – particularly those with special needs. Youth with neurologic conditions and their families often feel discouraged to work on long-term … Continue reading Transitioning to adult neurology care
Staring Spells – Primary Steps for Primary Care (11/6/2018) - Staring spells is a common chief complaint in pediatrics often noted by parents or teachers prompting evaluation. While absence seizures are certainly on the differential, staring can be many other things and careful history and evaluation is needed to guide evaluation and management. What is the differential of staring spells? Often times staring events in children represent transient inattention or daydreaming where the child … Continue reading Staring Spells – Primary Steps for Primary Care
Boy with closed eyes rubbing temples Headaches – Primary Steps for Primary Care (10/31/2018) - The start of the school year is just around the corner, and we frequently see an increase in calls regarding headaches around this time. We want to take this opportunity to review some basic steps in diagnosing and treating headaches. Nearly 10 percent of children have frequent or recurrent headaches. While this is a significant source of parental anxiety, the vast majority are benign … Continue reading Headaches – Primary Steps for Primary Care
Doctor with very young patient Febrile Seizures – Primary Steps for Primary Care (10/31/2018) - Febrile seizures are the most common seizure type in childhood, affecting 2-5 percent of children. These seizures are associated with a febrile illness in the absence of central nervous system infection or electrolyte imbalance, and they typically occur between the ages of 6 months and 5 years (peak 18 months). Most febrile seizures can be managed in a primary care setting. Below are answers … Continue reading Febrile Seizures – Primary Steps for Primary Care
boy grimacing and rubbing his temples Tics – Primary Steps for Primary Care (10/31/2018) - Tics are repetitive, stereotyped, involuntary movements that usually begin in childhood. They can consist of motor and vocal tics, such as excessive eye blinking/rolling, facial grimacing, neck or shoulder jerks, sniffing, throat clearing or other vocalizations. Tics can be transient or chronic. If chronic, it may meet the criteria for Tourette syndrome. Tourette syndrome is defined as multiple motor and vocal tics that have … Continue reading Tics – Primary Steps for Primary Care
Concussion – Primary Steps for Primary Care (10/8/2018) - A concussion is a trauma-related pathophysiological process that affects the neurometabolic function of the brain. Concussions are quite prevalent; the CDC reports 3.8 million sport-related brain injuries occur annually. It is estimated in middle school and high school children, up to 20% of children have suffered a concussion. In the majority of patients, post-concussive symptoms resolve within 10 days. By 1 month, 72% of … Continue reading Concussion – Primary Steps for Primary Care
Chiari I Malformations – Primary Steps for Primary Care (10/8/2018) - Anxiety related to unexpected abnormal findings disclosed by imaging studies obtained during workup of headache or trauma is a frequent reason for referral to neurosurgery. A frequent incidental imaging finding is a Chiari I malformation, i.e., the presence of low-lying cerebellar tonsils, usually unaccompanied by other significant imaging findings. While the estimated prevalence of Chiari malformations is 1 per 1000 people, the overwhelming majority are asymptomatic. … Continue reading Chiari I Malformations – Primary Steps for Primary Care